Clinical Decision Support System for Implementing Care Pathways in a Global Radiation Oncology Network

Abstract

<h3>Purpose/Objective(s)</h3> Evidence-based approaches to cancer care using established care pathways (CPs) are widely regarded as an effective way of improving quality and value in oncology. Yet, busy practicing oncologists can be overwhelmed with the quantity of literature and broad interpretation of evidence. In our global radiation oncology network, we developed a radiation oncology, clinical decision support (RO-CDS) system with evidence-based CPs to minimize variations in patient radiation treatments. This study assessed the usability and performance of our RO-CDS across Australia and UK radiation oncology centers. <h3>Materials/Methods</h3> We have developed a cloud-native RO-CDS (Horizon) that has been implemented with more than 241 radiation oncologists from diverse geographies (178 Australia and 63 UK) at 34 Australian centers and 15 UK centers. Horizon's CP library has been implemented for all treated disease sites and was developed in collaboration with participating radiation oncologists along with national guideline references (NCCN, EVIQ, NICE). Each CP defines an evidence-based radiation treatment approach for a specific cancer site including technical information for simulation and treatment. Horizon allows the oncologist to select from our CP library using a guided, templated workflow collecting high value distinct diagnosis, staging, medical data while pre-populating prescription, treatment and OAR info and data. The output (simulation and prescription structured data and PDFs) can be recorded in the application or sent to an EMR, which facilitates communication with care teams and payers. Horizon also provides access to view the physician schedule, clinic notes and labs, and patient chart information. During the implementation of Horizon, participants were asked to rate the performance of Horizon application and complete statements on a System Usability Scale (SUS) questionnaire. CP compliance was defined as no manual variations or edits to an approved CP by a prescribing physician. <h3>Results</h3> Since 2018, a total of 107,000 individualized prescriptions have been created in Horizon RO-CDS. Over this four-year period, overall compliance to approved CPs has improved from 86% to 97%. For usability, Horizon's SUS score was on average 84.2 (72.5 – 100), classified as an A score (excellent). Prescribing activities (clinical documentation and communication) involving all clinical care team members decreased by 20 minutes post-Horizon implementation saving valuable clinic time. Horizon prescription times for oncologists' software usage averaged 3 minutes per patient case irrespective of disease site. <h3>Conclusion</h3> Our cloud-native RO-CDS demonstrates that evidence-based CPs can be successfully implemented in a global radiation oncology network with high adherence rates, improved efficiency, and excellent usability. Future Horizon implementation includes our AI engine to automatically extract data from clinical reports reducing manual data entry.